Isla Bennett
Changes in the appearance of your nails, such as skin growing beneath them, can be harmless, but they can also indicate an underlying disease or condition. The skin under your nails is called the hyponychium, and it can sometimes overgrow, causing discomfort and increasing the risk of infection. This condition is known as Pterygium inversum unguis (PIU) and can be present from birth or acquired due to various factors. To determine the cause of skin growth under your nails, it is advisable to consult a dermatologist, who can provide an accurate diagnosis and appropriate treatment options.
| Characteristics | Values |
|---|---|
| Name | Hyponychium |
| Location | Skin just under the free edge of the nail, beyond the distal end of the nail bed, near the fingertip |
| Function | Acts as a barrier from germs and debris, preventing external substances from getting under the nails |
| Overgrowth Causes | Genetic factors, wearing long nails with gel or acrylic nails for too long, contact dermatitis, nail injury, lupus, psoriasis, eczema, peripheral artery disease (PAD), etc. |
| Overgrowth Symptoms | Pain during nail trimming, increased chance of infection, discomfort, thickened skin, scaling, nail separation from the nail bed, etc. |
| Treatment Options | Antifungal medication, cuticle oil, builder gel manicures, cuticle pushers, nail trephination, surgery, chemotherapy, radiation, etc. |
| Prevention | Trim toenails straight across to prevent ingrown toenails |
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What You'll Learn
Hyponychium (skin under the nail)
The hyponychium is the skin just under the free edge of the nail plate, located near the fingertip. It is a slightly thickened layer of skin that acts as a barrier from germs, debris, bacteria, allergens, and pathogens, preventing them from getting under the nails. This protective seal is formed together with the onychodermal band. The skin in this region contains white blood cells to help prevent infection.
However, the hyponychium can sometimes overgrow and become thicker, which can be uncomfortable and unsightly. This overgrowth can occur when the hyponychium attaches to the underside of the nail as it grows, which may be caused by wearing long nails with gel or acrylic nails for extended periods, contact dermatitis, or nail injury. It may also be genetic or present from birth. In some cases, it could be triggered by the chemicals in gel manicures, although this is not yet proven.
If you are experiencing hyponychium overgrowth, it is recommended to avoid cutting it to reduce the risk of infection. Instead, you can use a cuticle pusher to gently push back the skin. Consulting a dermatologist or doctor is advised if you are concerned about the overgrowth or if you are unsure of the underlying cause. They can provide guidance on the best treatment options, which may include avoiding certain manicures, topical corticosteroids, antifungal medication, or the use of cuticle oil to soften the thickened skin.
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Nail injuries
A nail injury can occur when any part of the nail becomes injured, including the nail, nail bed, cuticle, or the skin around the sides of the nail. This can be caused by a blow to the nail, closing the finger in a door or drawer, or by cutting, tearing, smashing, or bruising the nail. Smashing a finger in a door, hitting it with a hammer or other heavy object, or cutting it with a knife or sharp object can cause a nail injury. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails. Nails can become thickened, discoloured, and can lift away from the nail bed.
If the nail is torn or jagged, it should be trimmed to avoid further injury. If the nail lifts off the nail bed, it may be most comfortable to replace the nail and hold it in place with a bandage. Nails will not reattach to the nail bed after they have separated from it, but a new nail will usually regrow. If blood under the nail occupies more than half of the nail area, a physician should evaluate the finger as it could indicate an underlying bone fracture or tissue tear.
For more serious nail injuries, it is important to go to an urgent care centre or emergency room. Treatment will involve stopping the bleeding and cleaning the wound. The nail and finger or toe will usually be numbed with medicine before treatment. For larger bruises, a small hole may be created in the nail to allow blood and fluid to drain out, relieving pressure and pain. If the bone is broken or the bruise is very large, the nail may need to be removed and the nail bed repaired. Antibiotics may be prescribed to prevent infection.
Nail biting and cuticle biting can also cause trauma to the nails. Nail biting is a common cause of acute paronychia, a type of infection where bacteria get underneath the tissue at the side of the nail, causing swelling and irritation. Horizontal hatch marks in the middle of the nail can be caused by repetitive picking at the thumb nail and cuticle with the index finger.
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Nail matrix damage
The nail matrix is the area where your fingernails and toenails start to grow. Located at the base of the nail, it creates new cells that allow your nail to grow. Your nail may stop growing if the nail bed is injured. The matrix comprises two parts: the germinal matrix and the sterile matrix. The germinal matrix, located below the lunula (the white, half-moon cells at the nail's base) and closest to the knuckle, contributes about 90% of nail production, giving the nail its natural curvature. The remaining 10% of cells are formed by the sterile matrix, which is responsible for keeping the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and affect nail growth. Trauma to the nail can cause nail cell production to stop for up to three weeks, after which nail growth resumes at a faster and steadier rate. Deep cuts or crushing injuries to the germinal matrix can have long-term or permanent effects, and the nail may never grow back. Minor matrix damage can cause temporary changes in the nail's appearance, such as bruising, ridges, or a rough surface, and severe injuries can lead to chronic thickening, uneven growth, or complete and permanent nail loss.
In the case of nail matrix damage, it is essential to seek medical care. With proper treatment, healthy nails can often grow back. If the nail falls off due to severe injury, it usually grows back with appropriate medical attention. While it is rare for the nail matrix to be permanently damaged, preventing nail regrowth, it is important to consult a healthcare provider to determine the best course of action for restoring nail health.
Several conditions can affect the nail matrix. Subungual melanoma, for example, is a condition where cancerous cells grow in the nail matrix, causing striped discolouration. Pterygium unguis is another condition that causes scarring that extends to the nail matrix, resulting in ridged nails. Additionally, nail trauma can lead to temporary or lasting changes in nail growth, including discolouration, thickening, and irregularities. Protecting nails by wearing protective gloves during repetitive tasks or heavy lifting can help prevent injuries.
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Nail infections
Fungal nail infections, on the other hand, are characterised by thick, discoloured, and brittle nails that are prone to breaking. They are often caused by the same fungus that causes athlete's foot and can spread from person to person in warm, moist environments like communal showers. Treatment involves the long-term application of topical antifungal medications, and in some cases, oral antifungal tablets.
In rare cases, skin overgrowth under the nail can be indicative of an underlying condition. Pterygium inversum unguis (PIU) is an uncommon condition where the hyponychium (the skin just under the free edge of the nail) attaches to the underside of the nail as it grows. While scientists don't fully understand PIU, it is associated with autoimmune conditions like lupus and can also be triggered by external factors. Another condition, psoriasis, involves the overgrowth of skin cells in the hyponychium and nail bed, leading to scaling and buildup. Treatment for PIU and psoriasis may include cuticle oils and antifungal medications.
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Skin conditions
Skin growing under the nail is known as hyponychium. It is the skin just under the free edge of the nail, located beyond the distal end of the nail bed, near the fingertip. The hyponychium acts as a barrier to protect the nail from germs and debris. However, it can sometimes overgrow, leading to discomfort and an increased risk of infection. This condition is known as Pterygium Inversum Unguis (PIU), and it can be present from birth or acquired later in life.
There are several possible causes of hyponychium overgrowth. One common reason is genetic predisposition. Additionally, certain nail habits, such as wearing long gel or acrylic nails, can contribute to the condition. Contact dermatitis or nail injuries may also play a role in the development of PIU. In some cases, PIU may be associated with autoimmune conditions such as lupus.
To address hyponychium overgrowth, it is recommended to consult a dermatologist, who can examine the nails and provide appropriate treatment options. Antifungal medication may be prescribed if a fungal infection is present. Cuticle oil can also be applied to soften the thickened skin. For those who prefer gel manicures, switching to builder gel, also known as BIAB nails, can add a protective layer to the nail and reduce the growth of the hyponychium.
It is important to note that changes in nail colour, texture, or shape can sometimes indicate underlying health conditions. For example, yellow nails can be a sign of lung disease or rheumatoid arthritis. Deep grooves or pits in the nails, known as Beau lines, can indicate a previous interruption in nail growth due to factors such as fever, injury, chemotherapy, or major stress. In some cases, pitted nails may suggest a systemic disease affecting the entire body. Therefore, it is advisable to seek professional medical advice for a thorough evaluation and appropriate treatment plan.
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Frequently asked questions
The hyponychium is the skin just under the free edge of your nail, located near your fingertip. It acts as a barrier to protect your nail from germs and debris.
There are several reasons why skin grows under the nails. The hyponychium can sometimes overgrow due to factors such as genetics, wearing long nails with gel or acrylics, contact dermatitis, or nail injury.
Nail psoriasis can cause white lines, pitting, crumbling, and detachment of the nail from the nail bed (onycholysis). Nails may also turn yellow with pits that continue to get deeper.
A fungal nail infection can cause colour changes, thickening of the nails, and crumbling. It may spread to the skin between the toes and eventually to the fingernails.
It is recommended to see a board-certified dermatologist if you notice any changes in colour, texture, or shape, as this could be a sign of an infection or a more serious condition.
